Being Mortal and Spitting into the Wind
Life and death are filled with difficult issues, but failing to truly understand those issues makes them much worse.
Some close friends recently recommended a book by Atul Gawande entitled Being Mortal: Medicine and What Matters in the End. It bent my thinking 180 degrees, like a dog spitting into a 35-knot south wind in Oklahoma. The change of direction and potentially messy result came mostly as a result of tradeoffs.
Or, perhaps, it’s about seeing the forest for the trees, which can be hard to do when you’re miles deep into the forest and have been there for years. You just assume all the trees are this way, or that way, and that you should just keep chopping.
(By the way, I think I’m officially deciding to go with “tradeoffs” instead of the more strictly correct (for now) “trade-offs.” The language is evolving indeed).
Take a step back, and you can see that you might not even be heading the right direction, and could even be heading precisely the wrong way.
For years I’ve assumed, or just kind of “believed,” for lack of a better word, that physicians are fixers — that medicine is somewhat like an automotive shop for humans. You go in, they hook up the probe thingy to the terminal under the hood next to the washer fluid, and the diag box says you have a bad relay and the water pump is going bad. So they call up NAPA, you’re on your way shortly, if things go right, and you pretend you won’t later be seeing the medical bill. If I go to the doctor, it’s because something is “wrong” and of course my expectation is that “he’ll fix it” for me.
We’ve been treating care of the aged this same way. It’s wrong.
To be clear, I appreciate the remedies physicians often dispense, the insight they have in many cases, and the goal of healing.
But so often, and possibly even more often than not, what’s actually needed is management of overall well-being. And this what the book refused to let me avoid. (I somewhat hesitate even to write about it, because I really just want to say “please read the book” and fear I can’t articulate it in summary very well — nor even just my applications from it). We’ve all heard the phrase “the cancer treatment was worse than the cancer,” but what I didn’t appreciate was that this truth extends to many more circumstances and categories of care.
The book made that clear.
Imagine extending the physical life of a 93-year-old man by two months, but making those two months ten times worse than the preceding two months. And, to cap it off, imagine “enabling” him to die in circumstances, at the very end, that contradict his every desire for his final days — perhaps being at home with those he loves — instead, ushering him into a cold room with beeping lights, surrounded by confusion and strangers. Or, worse, imagine doing so but not even extending his life by the two months. And here’s the crucial thing: I’m not saying this was the providence otherwise sent upon him but, rather, the actual result of your actions. (Which yes, are ultimately providential as well, and that’s beside the point).
I think I may also have been fearing the admittedly slippery slope that envisions physician-assisted suicide. But that’s really not what’s in view here at all. Sure, the sheer messiness of life (and life’s mortal end) can raise some gut-wrenching questions even after you’ve read the book, but what’s really at stake isn’t an either-or dichotomy or even the nuclear question of “who gets to decide what ‘quality of life’ means or which life is worth living.” While those questions are extremely important, I’m just trying to understand what the primary issues are in senior care, as I deal with it in my own family, and how to approach them with a deeper and more broad understanding.
In no way is this an argument favoring “letting folks go” because they’ve outlived their usefulness or something. That callous and horrifying attitude is already pervasive as well, as the other extreme. It’s more a matter of considering what goals these individuals have, what matters to them, and what can be done to manage situations instead of always trying “fix” them, especially when the cold, hard truth is that there isn’t a real, temporal, fix. Certainly not a likely successful one.
Another important book for me is entitled Just Do Something, but in this context, that’s misplaced — yet almost always the rule instead of the exception. Car has an issue, hook it up and fix it, right? After all, we must do something, right?
The book did leave a gaping hole, roughly the size of Alaska, concerning true purpose and meaning when it comes to life itself, and death. Even without The True Meaning Himself being properly discussed or even mentioned, however, the difficult and balanced consideration of how we approach care toward the end of life was truly eye-opening.
You can find the book here on Amazon. Or somewhere else. Lots to think about here, and still processing…to be continued.
